Prospective analysis of bleeding events in left ventricular assist device patients
Background: Bleeding is a major cause of morbidity in patients with continuous flow left ventricular assist devices (LVADs). We sought to identify clinical predictors of bleeding within the first year of LVAD implantation. Methods: A prospective study was performed on 30 patients with HeartMate II i...
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| Veröffentlicht in: | International journal of artificial organs 2018-05, Vol.41 (5), p.269-276 |
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| container_title | International journal of artificial organs |
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| creator | Sherazi, Saadia Kouides, Peter Francis, Charles Lowenstein, Charles Julian Refaai, Majed Conley, Grace Johnson, Brent Alan Muchnik, Eugene Lien, Susan Massey, Howard Todd Alexis, Jeffrey Dean |
| description | Background:
Bleeding is a major cause of morbidity in patients with continuous flow left ventricular assist devices (LVADs). We sought to identify clinical predictors of bleeding within the first year of LVAD implantation.
Methods:
A prospective study was performed on 30 patients with HeartMate II implantation at the University of Rochester Medical Center, Rochester, New York, United States. Blood was collected within 1 week before implantation, and at 1, 3, and 30 ± 10 days after implantation. Blood samples were analyzed for prothrombin time (PT), international normalized ratio (INR), von Willebrand factor (vWF) activity, vWF antigen, vWF multimers, collagen binding assay, factor VIII, and epinephrine closure time. The first bleeding event within 1 year of implantation was recorded.
Results:
There were 17 (57%) patients with a bleeding event. The cumulative incidence of bleeding was 50% at 304 days. Age at the time of LVAD implantation was associated with higher risk of bleeding (hazard ratio (HR) = 1.05, 95% confidence interval (CI) = 1.01–1.10, p = 0.013). Higher baseline INR was also associated with increased risk of bleeding after adjusting for age at the time of implant (HR = 6.58, 95% CI = 1.21–35.70, p = 0.028). The bleeders and non-bleeders had similar hemostatic markers at all four time points. Prior to LVAD, mean epinephrine closure time was similar between bleeders and non-bleeders. However, post LVAD measurement of epinephrine, closure time was frequently limited by platelet clumping.
Conclusion:
Older age and baseline INR are associated with higher risk of bleeding in LVAD patients. Platelet clumping may suggest underlying platelet dysfunction and associated high risk of bleeding |
| doi_str_mv | 10.1177/0391398818762353 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2167804592</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_0391398818762353</sage_id><sourcerecordid>2167804592</sourcerecordid><originalsourceid>FETCH-LOGICAL-c332t-bbf2ed4d57df082a9a026c1671a436d6a3504579fb6cac80deae116502ed74033</originalsourceid><addsrcrecordid>eNp1kN1LwzAUxYMobk7ffZKAz9V8NUkfZfgFA0X0uaTJ7cjo1pq0g_33pmwqCD5dLvd3zuUchC4puaFUqVvCC8oLralWkvGcH6EpVUxkkghyjKbjORvvE3QW44oQKoXIT9GEFblkmugpensNbezA9n4L2GxMs4s-4rbGVQPg_GaJYQubPmK_wQ3UPR634O3QmIBNTHCPHWy9BdyZ3o_oOTqpTRPh4jBn6OPh_n3-lC1eHp_nd4vMcs76rKpqBk64XLmaaGYKQ5i0VCpqBJdOGp4TkauirqQ1VhMHBiiVOUkqJQjnM3S99-1C-zlA7MtVO4QUIZYs2eikLliiyJ6yKWgMUJdd8GsTdiUl5Vhi-bfEJLk6GA_VGtyP4Lu1BGR7IJol_H791_ALlTR5vg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2167804592</pqid></control><display><type>article</type><title>Prospective analysis of bleeding events in left ventricular assist device patients</title><source>SAGE Complete A-Z List</source><creator>Sherazi, Saadia ; Kouides, Peter ; Francis, Charles ; Lowenstein, Charles Julian ; Refaai, Majed ; Conley, Grace ; Johnson, Brent Alan ; Muchnik, Eugene ; Lien, Susan ; Massey, Howard Todd ; Alexis, Jeffrey Dean</creator><creatorcontrib>Sherazi, Saadia ; Kouides, Peter ; Francis, Charles ; Lowenstein, Charles Julian ; Refaai, Majed ; Conley, Grace ; Johnson, Brent Alan ; Muchnik, Eugene ; Lien, Susan ; Massey, Howard Todd ; Alexis, Jeffrey Dean</creatorcontrib><description>Background:
Bleeding is a major cause of morbidity in patients with continuous flow left ventricular assist devices (LVADs). We sought to identify clinical predictors of bleeding within the first year of LVAD implantation.
Methods:
A prospective study was performed on 30 patients with HeartMate II implantation at the University of Rochester Medical Center, Rochester, New York, United States. Blood was collected within 1 week before implantation, and at 1, 3, and 30 ± 10 days after implantation. Blood samples were analyzed for prothrombin time (PT), international normalized ratio (INR), von Willebrand factor (vWF) activity, vWF antigen, vWF multimers, collagen binding assay, factor VIII, and epinephrine closure time. The first bleeding event within 1 year of implantation was recorded.
Results:
There were 17 (57%) patients with a bleeding event. The cumulative incidence of bleeding was 50% at 304 days. Age at the time of LVAD implantation was associated with higher risk of bleeding (hazard ratio (HR) = 1.05, 95% confidence interval (CI) = 1.01–1.10, p = 0.013). Higher baseline INR was also associated with increased risk of bleeding after adjusting for age at the time of implant (HR = 6.58, 95% CI = 1.21–35.70, p = 0.028). The bleeders and non-bleeders had similar hemostatic markers at all four time points. Prior to LVAD, mean epinephrine closure time was similar between bleeders and non-bleeders. However, post LVAD measurement of epinephrine, closure time was frequently limited by platelet clumping.
Conclusion:
Older age and baseline INR are associated with higher risk of bleeding in LVAD patients. Platelet clumping may suggest underlying platelet dysfunction and associated high risk of bleeding</description><identifier>ISSN: 0391-3988</identifier><identifier>EISSN: 1724-6040</identifier><identifier>DOI: 10.1177/0391398818762353</identifier><identifier>PMID: 29562808</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Age ; Bleeding ; Blood ; Blood platelets ; Coagulation factors ; Collagen (type I) ; Confidence intervals ; Epinephrine ; Health care facilities ; Health risk assessment ; Heart ; Implantation ; Morbidity ; Patients ; Platelets ; Prothrombin ; Risk ; Ventricle ; Ventricular assist devices ; Von Willebrand factor</subject><ispartof>International journal of artificial organs, 2018-05, Vol.41 (5), p.269-276</ispartof><rights>The Author(s) 2018</rights><rights>Copyright Wichtig Editore s.r.l. May 2018</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c332t-bbf2ed4d57df082a9a026c1671a436d6a3504579fb6cac80deae116502ed74033</citedby><cites>FETCH-LOGICAL-c332t-bbf2ed4d57df082a9a026c1671a436d6a3504579fb6cac80deae116502ed74033</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0391398818762353$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0391398818762353$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29562808$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sherazi, Saadia</creatorcontrib><creatorcontrib>Kouides, Peter</creatorcontrib><creatorcontrib>Francis, Charles</creatorcontrib><creatorcontrib>Lowenstein, Charles Julian</creatorcontrib><creatorcontrib>Refaai, Majed</creatorcontrib><creatorcontrib>Conley, Grace</creatorcontrib><creatorcontrib>Johnson, Brent Alan</creatorcontrib><creatorcontrib>Muchnik, Eugene</creatorcontrib><creatorcontrib>Lien, Susan</creatorcontrib><creatorcontrib>Massey, Howard Todd</creatorcontrib><creatorcontrib>Alexis, Jeffrey Dean</creatorcontrib><title>Prospective analysis of bleeding events in left ventricular assist device patients</title><title>International journal of artificial organs</title><addtitle>Int J Artif Organs</addtitle><description>Background:
Bleeding is a major cause of morbidity in patients with continuous flow left ventricular assist devices (LVADs). We sought to identify clinical predictors of bleeding within the first year of LVAD implantation.
Methods:
A prospective study was performed on 30 patients with HeartMate II implantation at the University of Rochester Medical Center, Rochester, New York, United States. Blood was collected within 1 week before implantation, and at 1, 3, and 30 ± 10 days after implantation. Blood samples were analyzed for prothrombin time (PT), international normalized ratio (INR), von Willebrand factor (vWF) activity, vWF antigen, vWF multimers, collagen binding assay, factor VIII, and epinephrine closure time. The first bleeding event within 1 year of implantation was recorded.
Results:
There were 17 (57%) patients with a bleeding event. The cumulative incidence of bleeding was 50% at 304 days. Age at the time of LVAD implantation was associated with higher risk of bleeding (hazard ratio (HR) = 1.05, 95% confidence interval (CI) = 1.01–1.10, p = 0.013). Higher baseline INR was also associated with increased risk of bleeding after adjusting for age at the time of implant (HR = 6.58, 95% CI = 1.21–35.70, p = 0.028). The bleeders and non-bleeders had similar hemostatic markers at all four time points. Prior to LVAD, mean epinephrine closure time was similar between bleeders and non-bleeders. However, post LVAD measurement of epinephrine, closure time was frequently limited by platelet clumping.
Conclusion:
Older age and baseline INR are associated with higher risk of bleeding in LVAD patients. Platelet clumping may suggest underlying platelet dysfunction and associated high risk of bleeding</description><subject>Age</subject><subject>Bleeding</subject><subject>Blood</subject><subject>Blood platelets</subject><subject>Coagulation factors</subject><subject>Collagen (type I)</subject><subject>Confidence intervals</subject><subject>Epinephrine</subject><subject>Health care facilities</subject><subject>Health risk assessment</subject><subject>Heart</subject><subject>Implantation</subject><subject>Morbidity</subject><subject>Patients</subject><subject>Platelets</subject><subject>Prothrombin</subject><subject>Risk</subject><subject>Ventricle</subject><subject>Ventricular assist devices</subject><subject>Von Willebrand factor</subject><issn>0391-3988</issn><issn>1724-6040</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp1kN1LwzAUxYMobk7ffZKAz9V8NUkfZfgFA0X0uaTJ7cjo1pq0g_33pmwqCD5dLvd3zuUchC4puaFUqVvCC8oLralWkvGcH6EpVUxkkghyjKbjORvvE3QW44oQKoXIT9GEFblkmugpensNbezA9n4L2GxMs4s-4rbGVQPg_GaJYQubPmK_wQ3UPR634O3QmIBNTHCPHWy9BdyZ3o_oOTqpTRPh4jBn6OPh_n3-lC1eHp_nd4vMcs76rKpqBk64XLmaaGYKQ5i0VCpqBJdOGp4TkauirqQ1VhMHBiiVOUkqJQjnM3S99-1C-zlA7MtVO4QUIZYs2eikLliiyJ6yKWgMUJdd8GsTdiUl5Vhi-bfEJLk6GA_VGtyP4Lu1BGR7IJol_H791_ALlTR5vg</recordid><startdate>20180501</startdate><enddate>20180501</enddate><creator>Sherazi, Saadia</creator><creator>Kouides, Peter</creator><creator>Francis, Charles</creator><creator>Lowenstein, Charles Julian</creator><creator>Refaai, Majed</creator><creator>Conley, Grace</creator><creator>Johnson, Brent Alan</creator><creator>Muchnik, Eugene</creator><creator>Lien, Susan</creator><creator>Massey, Howard Todd</creator><creator>Alexis, Jeffrey Dean</creator><general>SAGE Publications</general><general>Wichtig Editore s.r.l</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QF</scope><scope>7QO</scope><scope>7QQ</scope><scope>7SC</scope><scope>7SE</scope><scope>7SP</scope><scope>7SR</scope><scope>7TA</scope><scope>7TB</scope><scope>7U5</scope><scope>8BQ</scope><scope>8FD</scope><scope>F28</scope><scope>FR3</scope><scope>H8D</scope><scope>H8G</scope><scope>JG9</scope><scope>JQ2</scope><scope>KR7</scope><scope>L7M</scope><scope>L~C</scope><scope>L~D</scope><scope>P64</scope></search><sort><creationdate>20180501</creationdate><title>Prospective analysis of bleeding events in left ventricular assist device patients</title><author>Sherazi, Saadia ; Kouides, Peter ; Francis, Charles ; Lowenstein, Charles Julian ; Refaai, Majed ; Conley, Grace ; Johnson, Brent Alan ; Muchnik, Eugene ; Lien, Susan ; Massey, Howard Todd ; Alexis, Jeffrey Dean</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c332t-bbf2ed4d57df082a9a026c1671a436d6a3504579fb6cac80deae116502ed74033</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Age</topic><topic>Bleeding</topic><topic>Blood</topic><topic>Blood platelets</topic><topic>Coagulation factors</topic><topic>Collagen (type I)</topic><topic>Confidence intervals</topic><topic>Epinephrine</topic><topic>Health care facilities</topic><topic>Health risk assessment</topic><topic>Heart</topic><topic>Implantation</topic><topic>Morbidity</topic><topic>Patients</topic><topic>Platelets</topic><topic>Prothrombin</topic><topic>Risk</topic><topic>Ventricle</topic><topic>Ventricular assist devices</topic><topic>Von Willebrand factor</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sherazi, Saadia</creatorcontrib><creatorcontrib>Kouides, Peter</creatorcontrib><creatorcontrib>Francis, Charles</creatorcontrib><creatorcontrib>Lowenstein, Charles Julian</creatorcontrib><creatorcontrib>Refaai, Majed</creatorcontrib><creatorcontrib>Conley, Grace</creatorcontrib><creatorcontrib>Johnson, Brent Alan</creatorcontrib><creatorcontrib>Muchnik, Eugene</creatorcontrib><creatorcontrib>Lien, Susan</creatorcontrib><creatorcontrib>Massey, Howard Todd</creatorcontrib><creatorcontrib>Alexis, Jeffrey Dean</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Aluminium Industry Abstracts</collection><collection>Biotechnology Research Abstracts</collection><collection>Ceramic Abstracts</collection><collection>Computer and Information Systems Abstracts</collection><collection>Corrosion Abstracts</collection><collection>Electronics & Communications Abstracts</collection><collection>Engineered Materials Abstracts</collection><collection>Materials Business File</collection><collection>Mechanical & Transportation Engineering Abstracts</collection><collection>Solid State and Superconductivity Abstracts</collection><collection>METADEX</collection><collection>Technology Research Database</collection><collection>ANTE: Abstracts in New Technology & Engineering</collection><collection>Engineering Research Database</collection><collection>Aerospace Database</collection><collection>Copper Technical Reference Library</collection><collection>Materials Research Database</collection><collection>ProQuest Computer Science Collection</collection><collection>Civil Engineering Abstracts</collection><collection>Advanced Technologies Database with Aerospace</collection><collection>Computer and Information Systems Abstracts Academic</collection><collection>Computer and Information Systems Abstracts Professional</collection><collection>Biotechnology and BioEngineering Abstracts</collection><jtitle>International journal of artificial organs</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sherazi, Saadia</au><au>Kouides, Peter</au><au>Francis, Charles</au><au>Lowenstein, Charles Julian</au><au>Refaai, Majed</au><au>Conley, Grace</au><au>Johnson, Brent Alan</au><au>Muchnik, Eugene</au><au>Lien, Susan</au><au>Massey, Howard Todd</au><au>Alexis, Jeffrey Dean</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prospective analysis of bleeding events in left ventricular assist device patients</atitle><jtitle>International journal of artificial organs</jtitle><addtitle>Int J Artif Organs</addtitle><date>2018-05-01</date><risdate>2018</risdate><volume>41</volume><issue>5</issue><spage>269</spage><epage>276</epage><pages>269-276</pages><issn>0391-3988</issn><eissn>1724-6040</eissn><abstract>Background:
Bleeding is a major cause of morbidity in patients with continuous flow left ventricular assist devices (LVADs). We sought to identify clinical predictors of bleeding within the first year of LVAD implantation.
Methods:
A prospective study was performed on 30 patients with HeartMate II implantation at the University of Rochester Medical Center, Rochester, New York, United States. Blood was collected within 1 week before implantation, and at 1, 3, and 30 ± 10 days after implantation. Blood samples were analyzed for prothrombin time (PT), international normalized ratio (INR), von Willebrand factor (vWF) activity, vWF antigen, vWF multimers, collagen binding assay, factor VIII, and epinephrine closure time. The first bleeding event within 1 year of implantation was recorded.
Results:
There were 17 (57%) patients with a bleeding event. The cumulative incidence of bleeding was 50% at 304 days. Age at the time of LVAD implantation was associated with higher risk of bleeding (hazard ratio (HR) = 1.05, 95% confidence interval (CI) = 1.01–1.10, p = 0.013). Higher baseline INR was also associated with increased risk of bleeding after adjusting for age at the time of implant (HR = 6.58, 95% CI = 1.21–35.70, p = 0.028). The bleeders and non-bleeders had similar hemostatic markers at all four time points. Prior to LVAD, mean epinephrine closure time was similar between bleeders and non-bleeders. However, post LVAD measurement of epinephrine, closure time was frequently limited by platelet clumping.
Conclusion:
Older age and baseline INR are associated with higher risk of bleeding in LVAD patients. Platelet clumping may suggest underlying platelet dysfunction and associated high risk of bleeding</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>29562808</pmid><doi>10.1177/0391398818762353</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0391-3988 |
| ispartof | International journal of artificial organs, 2018-05, Vol.41 (5), p.269-276 |
| issn | 0391-3988 1724-6040 |
| language | eng |
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| source | SAGE Complete A-Z List |
| subjects | Age Bleeding Blood Blood platelets Coagulation factors Collagen (type I) Confidence intervals Epinephrine Health care facilities Health risk assessment Heart Implantation Morbidity Patients Platelets Prothrombin Risk Ventricle Ventricular assist devices Von Willebrand factor |
| title | Prospective analysis of bleeding events in left ventricular assist device patients |
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